Endotracheal Intubation
• Confirmation that the tracheal tube is in place:
The presence of steam-moisture in the tracheal tube
Observation of tidal volume returning during expiration
Observing the rise and fall of the rib cage
Detection of end-tidal carbon dioxide (the most accurate indicator)
Auscultation of breath sounds
Visible tube in trachea on lateral neck radiograph
To confirm the location of the tube with laryngoscopy
Complications of intubation
During laryngoscopy and intubation
Incorrect placement
- Esophageal intubation
- Bronchial intubation
- Placement of the cuff in the larynx
airway trauma
- Tooth damage
- Laceration of the lip, tongue or mucosa
- Throat ache
- Mandible dislocation
- Retropharyngeal dissection
Physiological reflexes
- Hypertension, tachycardia
- intracranial hypertension
- Intraocular hypertension
- laryngospasm
Poor function of the tube
- Cuff perforation
If the tube is inserted
wrong settlement
- Involuntary extubation
- Bronchial intubation
- Laryngeal cuff position
Airway trauma
- Inflammation or ulceration of the mucosa
- Peeling of the skin of the nose
Wrong function of tube
- fire/explosion
- Blockage
Following extubation
airway trauma
- Edema and stenosis (glottic, subglottic or tracheal)
- Hoarseness (vocal cord granuloma or paralysis)
- Laryngeal dysfunction and laryngeal aspiration
laryngospasm
negative pressure pulmonary edema
Tracheal extubation
Post-Surgical Routine 'Awake' Extubation Criteria
Subjective Clinical Criteria
• spontaneous breathing
• Obeying commands
• Ability to lift head for five seconds
• Gag reflex intact
• Airway is clean
• Adequate pain control
• Minimal end expiratory concentration of inhalation anesthetics
Objective Criteria
• Vital capacity 10 ml/kg
• voluntary negative inspiratory peak pressure >= 20 cmH2Q
Complications of Tracheal Extubation
• Inability to maintain breathing (eg residual anesthetic)
• Hypoxia (eg atelectasis)
• Upper airway obstruction (eg edema, residual anesthetic/decreased upper airway tone)
• Obstruction associated with the vocal cord (eg, subglottic edema)
• Bronchospasm (airway stimulation caused by endotracheal tube)
• Aspiration (due to decreased gag and swallowing reflex)
• Hypertension
• Increased intracranial pressure
• Increased intraocular pressure
• Increased abdominal wall pressure (risk of surgical wound opening)